Protecting Patients from Automated Denials Act
Sponsored By: Representative Conaway, Herbert C. [D-NJ-3]
Introduced
Summary
This bill would limit how Medicare Advantage plans use artificial intelligence for prior-authorization denials by requiring strict safeguards, most importantly a _physician review and attestation_. It would also require clear disclosures, long-term records, regular reporting to HHS, and audit authority over AI use.
Show full summary
- Medicare Advantage enrollees would be told when AI was used in a denial and given the National Provider Identifier of the physician reviewer, giving patients more transparency about who signed off on the decision.
- Providers would receive a copy of the signed physician attestation, an opportunity to speak directly with the reviewer, and access to the individualized clinical basis for any denial.
- Plans must have a qualified physician reviewer who is licensed and board certified or eligible in the relevant specialty; keep records for 10 years; and start submitting reports to the Secretary by March 31, 2027 and every 90 days thereafter. The Secretary could audit plans, review algorithms and denial data, and must issue implementing regulations within one year after enactment.
Personalized for You
How does this bill affect your finances?
Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Protections for Medicare Advantage denials
This bill would stop Medicare Advantage plans from denying a prior authorization only because of artificial intelligence. It would apply to plan years beginning January 1, 2027. Plans would need a qualified physician reviewer, under the plan medical director, to review and sign an attestation that they used independent medical judgment and that AI did not generate or dictate the denial. Plans would give the provider the signed attestation, let the provider speak directly with the reviewer, tell the enrollee and provider that AI was used, and provide the reviewer’s NPI. Plans would keep records for at least 10 years, report AI-based denials to the Secretary every 90 days starting March 31, 2027, and the Secretary could audit these uses and must issue a final rule within one year after enactment. The bill would also define what counts as "artificial intelligence" and set standards for who qualifies as a physician reviewer (state license, board certification or eligibility, and relevant experience).
Sponsors & CoSponsors
Sponsor
Conaway, Herbert C. [D-NJ-3]
NJ • D
Cosponsors
Rep. Murphy, Gregory F. [R-NC-3]
NC • R
Sponsored 7/16/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov